In Response.

No abstract available

http://ift.tt/2sSxjvI

False Low ETCO2 Measurements From Carbon Dioxide Sampling Nasal Cannula and How to Correct the Situation.

No abstract available

http://ift.tt/2sRWTBb

Respiratory System Mechanics During Low Versus High Positive End-Expiratory Pressure in Open Abdominal Surgery: A Substudy of PROVHILO Randomized Controlled Trial.

BACKGROUND: In the 2014 PROtective Ventilation using HIgh versus LOw positive end-expiratory pressure (PROVHILO) trial, intraoperative low tidal volume ventilation with high positive end-expiratory pressure (PEEP = 12 cm H2O) and lung recruitment maneuvers did not decrease postoperative pulmonary complications when compared to low PEEP (0-2 cm H2O) approach without recruitment breaths. However, effects of intraoperative PEEP on lung compliance remain poorly understood. We hypothesized that higher PEEP leads to a dominance of intratidal overdistension, whereas lower PEEP results in intratidal recruitment/derecruitment (R/D). To test our hypothesis, we used the volumedependent elastance index %E2, a respiratory parameter that allows for noninvasive and radiation-free assessment of dominant overdistension and intratidal R/D. We compared the incidence of intratidal R/D, linear expansion, and overdistension by means of %E2 in a subset of the PROVHILO cohort. METHODS: In 36 patients from 2 participating centers of the PROVHILO trial, we calculated respiratory system elastance (E), resistance (R), and %E2, a surrogate parameter for intratidal overdistension (%E2 > 30%) and R/D (%E2

http://ift.tt/2trPm9c

A Descriptive Survey of Anesthesiology Residency Simulation Programs: How Are Programs Preparing Residents for the New American Board of Anesthesiology APPLIED Certification Examination?.

BACKGROUND: Anesthesiology residency programs may need new simulation-based programs to prepare residents for the new Objective Structured Clinical Examination (OSCE) component of the American Board of Anesthesiology (ABA) Primary Certification process. The design of such programs may require significant resources, including faculty time, expertise, and funding, as are currently needed for structured oral examination (SOE) preparation. This survey analyzed the current state of US-based anesthesiology residency programs regarding simulation-based educational programming for SOE and OSCE preparation. METHODS: An online survey was distributed to every anesthesiology residency program director in the US. The survey included 15 to 46 questions, depending on each respondent's answers. The survey queried current practices and future plans regarding resident preparation specifically for the ABA APPLIED examination, with emphasis on the OSCE. Descriptive statistics were summarized. [chi]2 and Fisher exact tests were used to test the differences in proportions across groups. Spearman rank correlation was used to examine the association between ordinal variables. RESULTS: The responding 66 programs (49%) were a representative sample of all anesthesiology residencies (N = 136) in terms of geographical location ([chi]2 P = .58). There was a low response rate from small programs that have 12 or fewer clinical anesthesia residents. Ninety-one percent (95% confidence interval [95% CI], 84% -95%) of responders agreed that it is the responsibility of the program to specifically prepare residents for primary certification, and most agreed that it is important to practice SOEs (94%; 95% CI, 88%-97%) and OSCEs (89%; 95% CI, 83%-94%). While 100% of respondents reported providing mock SOEs, only 31% (95% CI, 24%-40%) of respondents provided mock OSCE experiences. Of those without an OSCE program, 75% (95% CI, 64%-83%) reported plans to start one. The most common reasons for not having an OSCE program already in place, and the perceived challenges for implementing an OSCE program, were the same: lack of time (faculty and residents), expertise in OSCE development and assessment, and funding. CONCLUSIONS: The results provide data from residency programs for benchmarking their simulation curriculum and ABA APPLIED Examination preparation offerings. Despite agreement that residency programs should prepare residents for the ABA APPLIED Examination, many programs have yet to implement an OSCE preparation program, in part due to lack of financial resources, faculty expertise, and time. Additionally, in contrast to the SOE, the OSCE is a new format for ABA primary certification. As a result, the lack of consensus concerning preparation needs could be related to the amount information that is available regarding the examination content and assessment process. (C) 2017 International Anesthesia Research Society

http://ift.tt/2ts08w3

Postpartum Tubal Sterilization: Making the Case for Urgency.

The parturient who requests postpartum sterilization has given consideration to and has made decisions regarding this aspect of her medical care long before her delivery. She arrives at parturition expecting the postpartum procedure to be performed as intended. The American Congress of Obstetricians and Gynecologists has reaffirmed its opinion that postpartum sterilization is an urgent procedure, owing to the safety and superior effectiveness of tubal sterilization via minilaparotomy in the immediate postpartum period, and the adverse consequences for mothers, babies, and society when the procedure is not actualized as desired and intended. In contrast, recent practice guidelines for obstetric anesthesia address anesthetic procedural aspects and short-term safety but overlook the long-term complications and considerations associated with failure to perform postpartum sterilization as planned. In practice, procedure completion rates are strikingly low, reportedly ranging from 31% to 52%. Reasons for failure to complete abound and include inadequate resources or inavailability of necessary personnel; obstetrician reluctance due to concerns for patient regret in younger women or medical comorbidities; barriers related to provision of obstetric care in a religiously affiliated hospital, or incomplete, improperly completed, or unavailable original federal consent forms among Medicaid-insured women. The federal requirement to wait 30 days after signing informed consent, and to retain the original signed document to be physically verified at time of the procedure, serves as a significant source of health care disparity for Medicaid-dependent mothers. This article reviews these larger issues of maternal health and comprehensive maternal care to broaden the anesthesiologist's appreciation of major benefits and potential risks of postpartum sterilization, including long-term effects, to promote an evidence-based, informed, and proactive role in delivering equitable, safe, and optimal care for these patients. (C) 2017 International Anesthesia Research Society

http://ift.tt/2sSjVbc

Investigation of Two Prototypes of Novel Noncontact Technologies for Automated Real-Time Capture of Incremental Drug Administration Data From Syringes.

BACKGROUND: An ideal electronic anesthesia recording system would be capable of not only recording physiological data but also injectable drug doses given, including those given incrementally from one syringe, without recourse to manual data entry. We compared 2 prototype devices which wirelessly recognized individual syringes and measured changes in their plunger positions via 2 different optical noncontact means, allowing calculation of incremental drug doses given. METHODS: Both devices incorporated a radio-frequency identification reader, which wirelessly read a unique code from a radio-frequency identification tag within syringe drug labels. A custom-designed cradle oriented any inserted 1-mL to 20-mL syringe in a repeatable position. The "laser" device had a moving laser beam broken by the end of the syringe plunger. The infrared (IR) device measured time of travel of IR light from a sender to a syringe plunger and back to a receiver. Both devices could therefore determine the drug and volume administered since the previous occasion when any syringe had been used. For each syringe size of 1, 2, 5, 10, and 20 mL, 121 plunger-length measurements were made over their full range, with each machine against a reference method of water filling and weighing using a randomized de Bruijn sequence. RESULTS: For every syringe size, the laser device showed greater accuracy and precision, lower bias, and narrower limits of agreement (95% confidence intervals = bias +/- 1.96 SD) than the IR device when compared to the reference method. For all syringe sizes, the range of bias was -0.05 to 0.32 mL for the laser and -2.42 to 1.38 mL for the IR. Lin concordance correlation coefficient values for the IR versus reference methods ranged from 0.6259 to 0.9255, with the lowest coefficients seen in syringes with the shortest distance of plunger travel (2 and 5 mL), while in laser versus reference comparisons, these coefficients were similar (0.9641-0.9981) over all syringe lengths. CONCLUSIONS: Both devices measured syringe volume changes, demonstrating potential for measuring incremental drug doses, recording these, and also the time of each measurement. The IR device had no moving parts, which would be advantageous in a clinical situation. However, the current embodiment was not deemed accurate enough for clinical use, potentially remediable through improvements in hardware and software design. The laser device showed high accuracy and precision over all syringe sizes and contained volumes, and was considered potentially accurate enough for clinical use with suitable development. (C) 2017 International Anesthesia Research Society

http://ift.tt/2trF0Gr

Administration of Tetrahydrobiopterin (BH4) Protects the Renal Microcirculation From Ischemia and Reperfusion Injury.

BACKGROUND: Abdominal aortic aneurysm surgery with suprarenal cross-clamping is often associated with renal injury. Although the mechanism underlying such injury is unclear, tissue ischemia and reperfusion, which induces endothelial dysfunction and decreases the availability of tetrahydrobiopterin (BH4), may play a role. We evaluated whether BH4 administration prevents renal ischemia/reperfusion injury in an animal model of aortic cross-clamping. METHODS: Nineteen anesthetized, mechanically ventilated, and invasively monitored adult sheep were randomized into 3 groups: sham animals (n = 5) that underwent surgical preparation but no aortic clamping; an ischemia/reperfusion group (n = 7), where the aorta was clamped above the renal arteries for 1 hour, and a BH4 group (n = 7), in which animals received 20 mg/kg of BH4 followed by aortic cross-clamp for 1 hour. Animals were followed for a maximum of 6 hours after reperfusion. The renal microcirculation was evaluated at baseline (before clamping), and 1, 4, and 6 hours after reperfusion using side-stream dark field videomicroscopy. The renal lactate-to-pyruvate ratio was evaluated using microdialysis. The primary outcome was the change in proportion of small perfused vessels before and after injury. Secondary outcomes were renal tissue redox state and renal function. RESULTS: Ischemia/reperfusion injury was associated with increases in heart rate and mean arterial pressure, which were blunted by BH4 administration. From the first to the sixth hour after reperfusion, the small vessel density (estimated mean difference [EMD], 1.03; 95% confidence interval [CI], 0.41-1.64; P = .003), perfused small vessel density (EMD, 0.84; 95% CI, 0.29-1.39; P = .005), and proportion of perfused small vessels (EMD, 8.60; 95% CI, 0.85-16.30; P = .031) were altered less in the BH4 than in the ischemia/reperfusion group. The renal lactate-to-pyruvate ratios were lower in the cortex in the BH4 than in the ischemia/reperfusion group from the first to the sixth hour after reperfusion (EMD, -19.16; 95% CI, -11.06 to 33.16; P = .002) and in the medulla from the first to the fourth hour (EMD, -26.62; 95% CI, -18.32 to 38.30; P = .020; and EMD, -8.68; 95% CI, -5.96 to 12.65; P = .019). At the sixth hour, serum creatinine was lower in the BH4 than in the ischemia/reperfusion group (EMD, -3.36; 95% CI, -0.29 to 1.39; P = .026). CONCLUSIONS: In this sheep model of renal ischemia/reperfusion, BH4 pretreatment reduced renal microvascular injury and improved renal metabolism and function. Further work is needed to clarify the potential role of BH4 in ischemia/reperfusion injury. (C) 2017 International Anesthesia Research Society

http://ift.tt/2sSnnCm

Perioperative Surgical Home: Evaluation of a New Protocol Focused on a Multidisciplinary Approach to Manage Children Undergoing Posterior Spinal Fusion Operation.

BACKGROUND: The concept of Perioperative Surgical Home has been gaining significant attention in surgical centers. This model is delivering and improving coordinated care in a cost-effective manner to patients undergoing surgical procedures. It starts with the decision for surgical intervention, continues to the intraoperative and postoperative periods, and follows into long-term recovery. Constant re-evaluation of outcomes and modifications of delivery provides a feedback loop for improvement. Children's Hospital Los Angeles initiated a new protocol in June 2014 to manage children undergoing Posterior Spinal Fusion (PSF) with the goal to improve patient experience and lower the hospital length of stay and cost. METHODS: A retrospective chart review identified patients who underwent a PSF for idiopathic scoliosis before and after initiation of a new treatment protocol designed by a team of anesthesiologists, surgeons, nurses, and physical therapists. The new protocol included preoperative teaching of parents and patients, intraoperative anesthetic and surgical management, and immediate to long-term postoperative medical management. In addition to demographics, we examined length of stay, cost of hospitalization, pain scores on discharge, length of patient-controlled analgesia use, time to first solid food intake, and time to ambulation. RESULTS: Thirty-six patients were identified preinitiation and postinitiation of the protocol (total n = 72). There was no statistically significant difference in age, sex, use of intrathecal morphine, or estimated blood loss. Patients enrolled in the new protocol had higher American Society of Anesthesiologists classification (P = .003), significantly lower duration of patient-controlled analgesia use, time to first solid food intake, and time to ambulation (P= .001). The pain scores were higher at the time of discharge, although the difference was not statistically significant. Length of stay was significantly shorter in the new protocol group (P = .001), accounting for $292,560 in cost savings for the hospital. CONCLUSIONS: These data show that the cooperation of different teams in designing new management guidelines for patients requiring a PSF can significantly decrease the total length of stay and cost of hospitalization without altering quality of care. (C) 2017 International Anesthesia Research Society

http://ift.tt/2ts3Mq3

Pupillary Unrest: Is It a Generalizable Finding?.

No abstract available

http://ift.tt/2sRWSgB

Platelet Counts and Postoperative Stroke After Coronary Artery Bypass Grafting Surgery.

BACKGROUND: Declining platelet counts may reveal platelet activation and aggregation in a postoperative prothrombotic state. Therefore, we hypothesized that nadir platelet counts after on-pump coronary artery bypass grafting (CABG) surgery are associated with stroke. METHODS: We evaluated 6 130 adult CABG surgery patients. Postoperative platelet counts were evaluated as continuous and categorical (mild versus moderate to severe) predictors of stroke. Extended Cox proportional hazard regression analysis with a time-varying covariate for daily minimum postoperative platelet count assessed the association of day-to-day variations in postoperative platelet count with time to stroke. Competing risks proportional hazard regression models examined associations between day-to-day variations in postoperative platelet counts with timing of stroke (early: 0-1 days; delayed: >=2 days). RESULTS: Median (interquartile range) postoperative nadir platelet counts were 123.0 (98.0-155.0) x 109/L. The incidences of postoperative stroke were 1.09%, 1.50%, and 3.02% for platelet counts >150 x 109/L, 100 to 150 x 109/L, and 150 x 109/L. Importantly, such thrombocytopenia, defined as a time-varying covariate, was significantly associated with delayed (>=2 days after surgery; adjusted HR, 2.83; 95% CI, 1.48.5.41; P = .0017) but not early postoperative stroke. CONCLUSIONS: Our findings suggest an independent association between moderate to severe postoperative thrombocytopenia and postoperative stroke, and timing of stroke after CABG surgery. (C) 2017 International Anesthesia Research Society

http://ift.tt/2trJJrv

In Response.

No abstract available

http://ift.tt/2sS6JTt

Epidemiologic Analysis of Elective Operative Procedures in Infants Less Than 6 Months of Age in the United States.

BACKGROUND: This study uses publicly available data to analyze the total number of elective, potentially deferrable operative procedures involving infants

http://ift.tt/2trozK1

A Shared Opportunity for Improving Electronic Medical Record Data.

With the recent rapid adoption of electronic medical records (EMRs), studies reporting results based on EMR data have become increasingly common. While analyzing data extracted from our EMR for a retrospective study, we identified various types of erroneous data entries. This report investigates the root causes of the incompleteness, inconsistency, and inaccuracy of the medical records analyzed in our study. While experienced health information management professionals are well aware of the many shortcomings with EMR data, the aims of this case study are to highlight the significance of the negative impact of erroneous EMR data, to provide fundamental principles for managing EMRs, and to provide recommendations to help facilitate the successful use of electronic health data, whether to inform clinical decisions or for clinical research. (C) 2017 International Anesthesia Research Society

http://ift.tt/2sSrqyP

Assessment of Postoperative Analgesic Drug Efficacy: Method of Data Analysis Is Critical.

BACKGROUND: Pain intensity ratings and opioid consumption (OC) are ubiquitous indicators of pain in postoperative trials of the efficacy of interventional procedures. Unfortunately, consensus on the appropriate statistical handling of these outcomes has not been reached. The aim of this article was, therefore, to reexamine original data obtained from a postoperative analgesic drug trial, applying a collection of standard statistical methods in analgesic outcome assessments. Furthermore, a modified integrated assessment method of these outcomes was evaluated. METHODS: Data from a randomized, double-blind, placebo-controlled study investigating the analgesic efficacy of a regional anesthetic block following a major elective surgical procedure were analyzed. The original data included measurements of pain intensity (visual analog scale [VAS]) at rest and during coughing (VAS0/2/4/6/12/18/24 hrs) and OC0-6/0-24 hrs administered by patient-controlled analgesia. The statistical analyses included comparisons of discrete pain intensity scores (VAS0/2/4/6/12/18/24 hrs), summary measures of pain intensity ratings (area under the curve [AUC]-VAS0-6/0-24 hrs; mean VAS0-6/0-24 hrs), and OC0-6/0-24 hrs. Finally, the analyses also included an integrated assessment of longitudinally measured pain intensity and opioid consumption (PIOC0-6/0-24 hrs). Also, estimation of effect size, generalized odds ratio of the individual analgesic outcome variables was performed. RESULTS: Sixty-one patients were included in the final data analysis. Discrete pain intensity ratings differed significantly between the treatment groups at specific postoperative time points, but appropriate correction for multiple comparisons eliminated some of these differences. AUC-VAS0-6 hrs differed significantly at rest and during coughing, while no difference was found for AUC-VAS0-24 hrs. In contrast, mean VAS0-6 hrs and VAS0-24 hrs differed significantly between treatment groups at rest and during coughing. OC0-6/0-24 hrs differed significantly between the treatment groups. Finally, also PIOC0-6/0-24 hrs differed significantly at rest and during coughing. CONCLUSIONS: Our analyses demonstrate that the applied statistical method may alter the statistical significance and estimates of effect size of analgesic outcome variables in postoperative pain trials. Our findings underline the importance of defining valid statistical methods for future analgesic drug trials. We propose an integrated assessment of longitudinally measured pain intensity and opioid consumption (PIOC). The method combines two interdependent analgesic outcomes, lowers the risk of mass significance, and provides more accurate representation of the dynamic nature of postoperative pain and analgesic drug efficacy. (C) 2017 International Anesthesia Research Society

http://ift.tt/2trJKM5

Hospital-Based Acute Care Within 7 Days of Discharge After Outpatient Arthroscopic Shoulder Surgery.

BACKGROUND: The rate of hospital-based acute care (defined as hospital transfer at discharge, emergency department [ED] visit, or subsequent inpatient hospital [IP] admission) after outpatient procedure is gaining momentum as a quality metric for ambulatory surgery. However, the incidence and reasons for hospital-based acute care after arthroscopic shoulder surgery are poorly understood. METHODS: We studied adult patients who underwent outpatient arthroscopic shoulder procedures in New York State between 2011 and 2013 using the Healthcare Cost and Utilization Project database. ER visits and IP admissions within 7 days of surgery were identified by cross-matching 2 independent Healthcare Cost and Utilization Project databases. RESULTS: The final cohort included 103,476 subjects. We identified 1867 (1.80%, 95% confidence interval [CI], 1.72%-1.89%) events, and the majority of these encounters were ER visits (1643, or 1.59%, 95% CI, 1.51%-1.66%). Direct IP admission after discharged was uncommon (224, or 0.22%, 95% CI, 0.19%-0.24%). The most common reasons for seeking acute care were musculoskeletal pain (23.78% of all events). Nearly half of all events (43.49%) occurred on the day of surgery or on postoperative day 1. Operative time exceeding 2 hours was associated with higher odds of requiring acute care (odds ratio [OR], 1.28; 99% CI, 1.08-1.51). High-volume surgical centers (OR, 0.67; 99% CI, 0.58-0.78) and regional anesthesia (OR, 0.72; 99% CI, 0.56-0.92) were associated with lower odds of requiring acute care. CONCLUSIONS: The rate of hospital-based acute care after outpatient shoulder arthroscopy was low (1.80%). Complications driving acute care visits often occurred within 1 day of surgery. Many of the events were likely related to surgery and anesthesia (eg, inadequate analgesia), suggesting that anesthesiologists may play a central role in preventing acute care visits after surgery. (C) 2017 International Anesthesia Research Society

http://ift.tt/2trNcGK

Creation and Execution of a Novel Anesthesia Perioperative Care Service at a Veterans Affairs Hospital.

Physician-led perioperative surgical home models are developing as a method for improving the American health care system. These models are novel, team-based approaches that help to provide continuity of care throughout the perioperative period. Another avenue for improving care for surgical patients is the use of enhanced recovery after surgery pathways. These are well-described methods that have shown to improve perioperative outcomes. An established perioperative surgical home model can help implementation, efficiency, and adherence to enhanced recovery after surgery pathways. For these reasons, the Tennessee Valley Healthcare System, Nashville Veterans Affairs Medical Center created an Anesthesiology Perioperative Care Service that provides comprehensive care to surgical patients from their preoperative period through the continuum of their hospital course and postdischarge follow-up. In this brief report, we describe the development, implementation, and preliminary outcomes of the service. (C) 2017 International Anesthesia Research Society

http://ift.tt/2sScaSj

Stroke Volume Variation-Guided Versus Central Venous Pressure-Guided Low Central Venous Pressure With Milrinone During Living Donor Hepatectomy: A Randomized Double-Blinded Clinical Trial.

BACKGROUND: We previously demonstrated the usefulness of milrinone for living donor hepatectomy. However, a less-invasive alternative to central venous catheterization and perioperative contributors to good surgical outcomes remain undetermined. The current study evaluated whether the stroke volume variation (SVV)-guided method can substitute central venous catheterization during milrinone-induced profound vasodilation. METHODS: We randomly assigned 42 living liver donors to receive either SVV guidance or central venous pressure (CVP) guidance to obtain milrinone-induced low CVP. Target SVV of 9% was used as a substitute for CVP of 5 mm Hg. The surgical field grade evaluated by 2 attending surgeons on a 4-point scale was compared between the CVP- and SVV-guided groups (n = 19, total number of scores = 38 per group) as a primary outcome variable. Multivariable analysis was performed to identify independent factors associated with the best surgical field as a post hoc analysis. RESULTS: Surgical field grades, which were either 1 or 2, were not found to be different between the 2 groups via Mann-Whitney U test (P = .358). There was a very weak correlation between SVV and CVP during profound vasodilation such as CVP

http://ift.tt/2tro0jt

Improving Outcomes in Emergency General Surgery Patients: What Evidence Is Out There?.

No abstract available

http://ift.tt/2sSrqij

Cardiac cycle efficiency and dicrotic pressure variations: new parameters for fluid therapy: A pilot observational study.

BACKGROUND: During a fluid challenge, the changes in cardiac performance and peripheral circulatory tone are closely related to the position of the ventricle on the Frank-Starling curve. Some patients have a good haemodynamic response to a fluid challenge, others hardly any response. The early haemodynamic effects of a fluid challenge could predict the final response before the entire fluid volume has been administered. OBJECTIVE: To assess whether a multivariate logistic regression model, including pulse pressure variation (PPV), cardiac cycle efficiency (CCE), arterial elastance and the difference between the dicrotic pressure and both systolic and mean arterial pressure (SAP - Pdic and MAP - Pdic) can predict cardiac responsiveness early during a fluid challenge in comparison with the standard procedure described elsewhere. DESIGN: Observational pilot study. SETTING: Elective surgical patients undergoing laparotomy, enrolled in two Italian University Hospitals. PATIENTS: Fifty adult surgical patients, ventilated with a lung protective strategy, were enrolled and data from 46 were analysed. INTERVENTIONS: A fluid challenge consisting of 500 ml of crystalloid infused over 10 min. MAIN OUTCOME MEASURES AND ANALYSIS: The changes in CCE, arterial elastance, SAP - Pdic and MAP - Pdic were compared using analysis of variance. A multivariate logistic regression analysis utilising baseline values and the first minute measuring a variation statistically significant for the considered variables. RESULTS: At baseline, PPV correctly identified 70% of patients (89% of non-responders; 42% of responders). The model, including baseline PPV, [DELTA]CCE and [DELTA]SAP - Pdic, correctly identified the efficiency of fluid challenge in 87% of patients (84.2% of responders; 92.5 of non-responders) after 5 min from fluid challenge infusion. CONCLUSION: In this pilot study conducted in a population of surgical patients mechanically ventilated with a VT less than 8 ml kg-1, a dynamic model of fluid challenge assessment, including PPV, [DELTA]CCE and [DELTA]SAP - Pdic, enhances the prediction of fluid challenge response after 5 min of a 10-min administration. TRIAL REGISTRATION: ACTRN12616001479493. (C) 2017 European Society of Anaesthesiology

http://ift.tt/2sOKLAe

Pulse photoplethysmographic amplitude and heart rate variability during laparoscopic cholecystectomy: A prospective observational study.

BACKGROUND: Surgical stress affects the autonomic nervous system by increasing sympathetic outflow. One method of monitoring sympathetic activity is pulse photoplethysmographic analysis. From this two indices can be derived - autonomic nervous system state (ANSS) and ANSS index (ANSSi). It has recently been claimed that these indices can be used to measure sympathetic activity in anaesthetised patients, but their validity has not yet been demonstrated. OBJECTIVE: To measure changes in pulse photoplethysmographic indices and determine any agreement with autonomic nervous system modulation of the cardiovascular system in healthy study participants during surgery under general anaesthesia. DESIGN: Prospective observational study. SETTING: Single-centre study based at a tertiary care centre in Milan, Italy. PATIENTS: Healthy patients undergoing general anaesthesia for elective laparoscopic cholecystectomy. INTERVENTIONS: ANSS, ANSSi, and heart rate variability (HRV) were analysed at three main times: baseline, after induction of general anaesthesia, and after pneumoperitoneum insufflation. MAIN OUTCOME MEASURES: The magnitude of changes in photoplethysmographic and HRV indices was measured. The agreement between pulse photoplethysmographic and HRV-derived indices was assessed by Bland-Altman plots. RESULTS: In total, 52 patients were enrolled and their data analysed. Both pulse photoplethysmographic and HRV indices changed during the study phases. An agreement was found between ANSSi and low frequency spectral components of HRV [bias 10.2nu, 95% confidence interval (CI) -13 to 33.4], high frequency spectral components of HRV (bias 6.1 nu, 95% CI -16.3-28.6), and low frequency/high frequency ratio (bias 16.1nu, 95% CI -1.4-33.5). The agreement was weaker between ANSSI and HRV indices. CONCLUSION: The study endorses the use of pulse photoplethysmographic indices ANSS and ANSSi as surrogates to estimate changes of autonomic modulation of the cardiovascular system in healthy adults during surgery under general anaesthesia. Orcid ID: http://ift.tt/2tMAaTr. (C) 2017 European Society of Anaesthesiology

http://ift.tt/2sOK3mq

The relative effects of dexmedetomidine and propofol on cerebral blood flow velocity and regional brain oxygenation: A randomised noninferiority trial.

BACKGROUND: Dexmedetomidine constricts cerebral blood vessels without a concomitant reduction in cerebral metabolic oxygen consumption. Its safety as a sedative in patients with neurological diseases thus remains uncertain. OBJECTIVE: Our primary objective was to test the hypothesis that dexmedetomidine is noninferior to propofol as regards cerebral blood flow (CBF) velocity and brain oxygenation. DESIGN: Unblinded randomised trial. SETTING: Cleveland Clinic Hospital, Cleveland, from November 2010 to July 2013. PATIENTS: Forty-four patients scheduled for insertion of a deep-brain stimulating electrodes. INTERVENTIONS: Patients were randomised to receive either dexmedetomidine or propofol sedation during deep-brain stimulating electrode insertion. MAIN OUTCOME MEASURES: Intraoperative CBF velocity was measured with transcranial Doppler, and brain oxygenation was assessed with near-infrared spectroscopy. Noninferiority of dexmedetomidine to propofol was defined as a less than 20% difference in means. RESULTS: Twenty-three patients were given dexmedetomidine and 21 propofol. Baseline characteristics and operative management were similar in each group. Dexmedetomidine was noninferior to propofol on both CBF and brain oxygenation, confirming our primary hypothesis. For cerebral flood flow, the estimated ratio of means (dexmedetomidine/propofol) was 0.94 [90% CI: 0.84 to 1.05], P = 0.011 for noninferiority. For brain oxygenation, the estimated ratio of means was 0.99 [90% CI: 0.96 to 1.02], P

http://ift.tt/2sOmPg7

Changes in rheology of self-consolidating concrete induced by pumping

Pumping is an easy and flexible process to place concrete inside a formwork. Many studies have recently been performed to understand and optimize the pumping process and identify the main differences between pumping of conventional vibrated concrete and self-consolidating concrete (SCC). However, due to pumping, changes in fresh concrete properties and the air-void system have been noticed. This paper describes the consequences of pumping on the fresh properties of SCC by means of two experimental pumping campaigns. In many cases, the concrete undergoes a large shear rate in the pipe, thus (re-)dispersing cement particles. This is expected to be the main cause of the observed decrease in plastic viscosity, V-Funnel flow time and pumping pressure resulting from increased flow rate or pumping time. The changes in yield stress or slump flow are anticipated to be influenced by the same phenomenon, but the final outcome is assumed to depend on the availability of residual superplasticizer in the mixing water. Pumping can cause a stable SCC to become segregating if both the yield stress and plastic viscosity decrease, or it can provoke a significant loss in filling ability, passing ability and self-consolidation of the concrete if the yield stress increases dramatically.

http://ift.tt/2sSb0WZ

Which parameters, other than the water content, influence the robustness of cement paste with SCC consistency?

Robustness is the capacity of cement-based mixtures to tolerate small variations in constituent elements, mixing parameters or temperature. It is an important reason slowing down the practical implementation of self-consolidating concrete (SCC). Especially the sensitivity of fresh SCC properties to a small variation in water content can be found in literature. The influence of the mixing sequence and mixing procedure on the robustness of SCC mixtures is not extensively reported. The present paper evaluates the effect of mixing time, mixing speed and the addition time of superplasticizer on the rheological properties of cement pastes with SCC consistency, which can be related to SCC mixtures. By means of rheology, the changes induced by the variations in mixing procedure are compared to the changes induced by the variations in water and superplasticizer content. The results indicate that changing the water content is the main factor influencing rheology of cement pastes with low water-to powder ratio (w/p). However, with increased water content in the paste mix design, other factors, such as adding time of the superplasticizer and mixing speed have equal or even superior importance as changing the water content. Dependent on the mix design, it may thus be necessary to use variables other than the water content to study robustness.

http://ift.tt/2trlA4z

Achalasia leading to diagnosis of adenocarcinoma of the oesophagus

A 50-year-old male with a 7 month history of progressive dysphagia to solids then subsequently to liquids. He underwent a diagnostic gastroscopy which was normal. A further barium swallow suggested achalasia. He was referred to a tertiary centre, where he underwent pH and manometry studies which confirmed a diagnosis of achalasia. He was referred for a laparoscopic cardiomyotomy, and at surgery there was a suspected tumour at the gastro-oesophageal junction. A follow-up endoscopy with biopsies was normal. Following this, a positron emission tomography scan showed T3 distal oesophageal cancer with no nodal involvement or distal metastasis. An attempt at oesophagectomy was performed, but at operation there was locally advanced carcinoma infiltrating the coeliac axis. He is currently undergoing palliative chemotherapy.

http://ift.tt/2rBuFX3

Racial disparity in mycosis fungoides: An analysis of 4495 cases from the US National Cancer Database

Studies have shown contradictory results regarding the survival outcomes among white, African American, and Asian patients with mycosis fungoides (MF).

http://ift.tt/2tLD22Z

Association of bullous pemphigoid with malignancy: A systematic review and meta-analysis

Studies evaluating whether malignancy rate is increased in patients with bullous pemphigoid (BP) have reached conflicting results.

http://ift.tt/2sOl2YE

Per Operative Study of Relation of Zuckerkandl Tubercle with Recurrent Laryngeal Nerve in Thyroid Surgery

Abstract

To identify Zuckerkandl tubercle and to determine relationship between the recurrent laryngeal nerve and Zuckerkandl tubercle (ZT). Peroperative study. Intraoperatively Zuckerkandl tubercle was identified. Size of the thyroid lobe and Zuckerkandl tubercle were co-related and direction of tubercle in relation to recurrent laryngeal nerve was examined. Grading of tubercle on the basis of size was done. We studied its direction and relation with recurrent laryngeal nerve. ZT was identified in 87.86% (179 out of 206) of cases. In the study amongst the 179 cases in whom ZT could be identified, ZT was found on the right side (85.41% i.e. 123 out of 144), 81.41% (92 out of 113) to the left side and 15.68% (8 out of 51) were B/L. ZT was found posterior to the tubercle in 97.22%(175 out of 179) cases and anterior to the tubercle in 2.77% (5 out of 179) cases. The relationship between recurrent laryngeal nerve and ITA was studied. ITA was anterior to RLN (in 70.89%) and posterior to RLN in 29.10%. Thus, ZT is an important landmark for identification of RLN during thyroidectomy (p value 0.001).

Level of evidence III

http://ift.tt/2sndA61

Odontogenic orbital cellulitis associated with cavernous sinus thrombosis and pulmonary embolism: a case report

This case illustrates the importance of prompt assessment and treatment of orbital cellulitis. In fact the ocular signs and symptoms may be associated with systemic complications which should be investigated a...

http://ift.tt/2snz6aI

Characterization of slow-cycling cells in the mouse cochlear lateral wall

by Yang Li, Kotaro Watanabe, Masato Fujioka, Kaoru Ogawa

Cochlear spiral ligament fibrocytes (SLFs) play essential roles in the physiology of hearing including ion recycling and the generation of endocochlear potential. In adult animals, SLFs can repopulate after damages, yet little is known about the characteristics of proliferating cells that support SLFs' self-renewal. Here we report in detail about the characteristics of cycling cells in the spiral ligament (SL). Fifteen P6 mice and six noise-exposed P28 mice were injected with 5-bromo-2′-deoxyuridine (BrdU) for 7 days and we chased BrdU retaining cells for as long as 60 days. Immunohistochemistry revealed that the BrdU positive IB4 (an endotherial marker) negative cells expressed an early SLF marker Pou3f4 but negative for cleaved-Caspase 3. Marker studies revealed that type 3 SLFs displayed significantly higher percentage of BrdU⁺ cells compared to other subtypes. Notably, the cells retained BrdU until P72, demonstrating they were dividing slowly. In the noise-damaged mice, in contrast to the loss of the other types, the number of type 3 SLFs did not altered and the BrdU incorporating- phosphorylated Histone H3 positive type 3 cells were increased from day 1 to 14 after noise exposure. Furthermore, the cells repopulating type 1 area, where the cells diminished profoundly after damage, were positive for the type 3 SLF markers. Collectively, in the latral wall of the cochlea, type 3 SLFs have the stem cell capacity and may contribute to the endogenous regeneration of lateral wall spiral ligament. Manipulating type 3 cells may be employed for potential regenerative therapies.

http://ift.tt/2sSYgiI

Per Operative Study of Relation of Zuckerkandl Tubercle with Recurrent Laryngeal Nerve in Thyroid Surgery

Abstract

To identify Zuckerkandl tubercle and to determine relationship between the recurrent laryngeal nerve and Zuckerkandl tubercle (ZT). Peroperative study. Intraoperatively Zuckerkandl tubercle was identified. Size of the thyroid lobe and Zuckerkandl tubercle were co-related and direction of tubercle in relation to recurrent laryngeal nerve was examined. Grading of tubercle on the basis of size was done. We studied its direction and relation with recurrent laryngeal nerve. ZT was identified in 87.86% (179 out of 206) of cases. In the study amongst the 179 cases in whom ZT could be identified, ZT was found on the right side (85.41% i.e. 123 out of 144), 81.41% (92 out of 113) to the left side and 15.68% (8 out of 51) were B/L. ZT was found posterior to the tubercle in 97.22%(175 out of 179) cases and anterior to the tubercle in 2.77% (5 out of 179) cases. The relationship between recurrent laryngeal nerve and ITA was studied. ITA was anterior to RLN (in 70.89%) and posterior to RLN in 29.10%. Thus, ZT is an important landmark for identification of RLN during thyroidectomy (p value 0.001).

Level of evidence III

http://ift.tt/2sndA61

Atopic dermatitis is associated with anxiety, depression, and suicidal ideation, but not with hospitalization or suicide

Abstract

Background

Atopic dermatitis (AD) has been linked with psychiatric disease in adults. However, the exact relationship and its consequences have been insufficiently studied. Our aim in this study was to assess the association between depression, anxiety and AD in adults, and examine the risk of hospitalization and suicide.

Methods

We utilized questionnaire data from a large general population study with data on social habits and psychiatric symptoms to compare prevalences of depression, anxiety, suicidal ideation, and anxiety attacks, in adults with and without a history of AD. Additionally we used nationwide hospital/clinic registry and prescription data to examine the risk of anxiety and depression in Danish adults with mild and moderate-severe AD, as well as the risk of hospitalization and suicide.

Results

In the general population study, those with AD reported clinician-diagnosed depression and anxiety more often than non-AD subjects, and had an increased prevalence of suicidal ideation and depressive symptoms. In the health registry study, moderate-severe AD patients had increased risk of antidepressant and anxiolytic medication use, while patients with mild AD only had increased risk of anxiolytic medication use. There was no increased risk of hospitalization or outpatient contacts due to depression or anxiety, or risk of suicide in AD patients.

Conclusions

Depression, anxiety, and suicidal ideation are more common among AD individuals, but do not to lead to psychiatric consultations, hospitalization, or suicide.

This article is protected by copyright. All rights reserved.

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A prospective microbiome-wide association study of food sensitization and food allergy in early childhood

Abstract

Background

Alterations in the intestinal microbiome are prospectively associated with the development of asthma; less is known regarding the role of microbiome alterations in food allergy development.

Methods

Intestinal microbiome samples were collected at age 3-6 months in children participating in the follow-up phase of an interventional trial of high dose Vitamin D given during pregnancy. At age 3, sensitization to foods (milk, egg, peanut, soy, wheat, walnut) was assessed. Food allergy was defined as caretaker report of healthcare provider-diagnosed allergy to the above foods prior to age 3 with evidence of IgE sensitization. Analysis was performed using Phyloseq and DESeq2; p-values were adjusted for multiple comparisons.

Results

Complete data were available for 225 children; there were 87 cases of food sensitization and 14 cases of food allergy. Microbial diversity measures did not differ between food sensitization and food allergy cases and controls. The genera Haemophilus (log₂ fold change -2.15, p=0.003), Dialister (log₂ fold change -2.22, p=0.009), Dorea (log₂ fold change -1.65, p=0.02) and Clostridium (log₂ fold change -1.47, p=0.002) were underrepresented among subjects with food sensitization. The genera Citrobacter (log₂ fold change -3.41, p=0.03), Oscillospira (log₂ fold change -2.80, p=0.03), Lactococcus (log₂ fold change -3.19, p=0.05) and Dorea (log₂ fold change -3.00, p=0.05) were underrepresented among subjects with food allergy.

Conclusions

The temporal association between bacterial colonization and food sensitization and allergy suggests that the microbiome may have a causal role in the development of food allergy. Our findings have therapeutic implications for the prevention and treatment of food allergy.

This article is protected by copyright. All rights reserved.

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Critical biological parameters modulate affinity as a determinant of function in T-cell receptor gene-modified T-cells

Abstract

T-cell receptor (TCR)-pMHC affinity has been generally accepted to be the most important factor dictating antigen recognition in gene-modified T-cells. As such, there is great interest in optimizing TCR-based immunotherapies by enhancing TCR affinity to augment the therapeutic benefit of TCR gene-modified T-cells in cancer patients. However, recent clinical trials using affinity-enhanced TCRs in adoptive cell transfer (ACT) have observed unintended and serious adverse events, including death, attributed to unpredicted off-tumor or off-target cross-reactivity. It is critical to re-evaluate the importance of other biophysical, structural, or cellular factors that drive the reactivity of TCR gene-modified T-cells. Using a model for altered antigen recognition, we determined how TCR–pMHC affinity influenced the reactivity of hepatitis C virus (HCV) TCR gene-modified T-cells against a panel of naturally occurring HCV peptides and HCV-expressing tumor targets. The impact of other factors, such as TCR–pMHC stabilization and signaling contributions by the CD8 co-receptor, as well as antigen and TCR density were also evaluated. We found that changes in TCR–pMHC affinity did not always predict or dictate IFNγ release or degranulation by TCR gene-modified T-cells, suggesting that less emphasis might need to be placed on TCR–pMHC affinity as a means of predicting or augmenting the therapeutic potential of TCR gene-modified T-cells used in ACT. A more complete understanding of antigen recognition by gene-modified T-cells and a more rational approach to improve the design and implementation of novel TCR-based immunotherapies is necessary to enhance efficacy and maximize safety in patients.

http://ift.tt/2rRDQBU

Improve endotracheal intubation with First and TEN approach

Taking the time to prepare for intubation success on the First pass and following the Tongue, Epiglottis and arytenoid Notch landmarks will stack the cards in your favor during both routine and difficult airway scenarios. When attempting endotracheal intubation, most paramedics focus on quickly visualizing the vocal cords so I developed the First and TEN approach to slow the process to improve first ...

http://ift.tt/2sx6qur

IL-18/IL-15/IL-12 synergy induces elevated and prolonged IFN-γ production by ex vivo expanded NK cells which is not due to enhanced STAT4 activation

Publication date: August 2017
Source:Molecular Immunology, Volume 88
Author(s): Evan Lusty, Sophie M. Poznanski, Karen Kwofie, Talveer S. Mandur, Dean A. Lee, Carl D. Richards, Ali A. Ashkar
The synergistic effect of IL-18/IL-15/IL-12 stimulation potently activates NK cells, inducing high levels of IFN-γ production. As a result of this potent stimulatory effect, NK cell pre-activation with IL-18/IL-15/IL-12 is being developed as a cancer immunotherapy. Ex vivo expansion of NK cells enables the efficient generation of large numbers of NK cells for wide-scale and repeated therapeutic use, and is thus an important source of NK cells for clinical application. However, the effects of IL-18/IL-15/IL-12 stimulation on ex vivo expanded NK cells have not yet been assessed. Thus, the present study assessed the effects of IL-18/IL-15/IL-12 stimulation on NK cells expanded ex vivo using K562-based artificial antigen presenting cells expressing membrane-bound IL-21. We report that ex vivo expanded NK cells stimulated with IL-18/IL-15/IL-12 produce high levels of IFN-γ and TNFα, have potent cytotoxicity, and maintain prolonged IFN-γ production following removal of stimulation. IL-18/IL-15/IL-12 stimulation induces a phenotypically unique IFN-γ-producing population with reduced CD16 expression and greater CD25 expression as compared to stimulated IFN-γ- NK cells and unstimulated NK cells. We elucidate that the mechanism of synergy for induction and maintenance of IFN-γ production is not due to a further enhancement of STAT4 activation compared to stimulation with IL-12 alone. Furthermore, we demonstrate that the synergistic increase in IFN-γ is not solely under translational regulation, as elevated levels of IFN-γ mRNA contribute to the synergistic increase in IFN-γ. Overall, this study characterizes the response of ex vivo expanded NK cells to IL-18/IL-15/IL-12 stimulation and supports the use of ex vivo expanded NK cells as a feasible and efficient source of IL-18/IL-15/IL-12 pre-activated NK cells for adoptive transfer in cancer immunotherapies.



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Effect of C1-INH on ischemia/reperfusion injury in a porcine limb ex vivo perfusion model

Publication date: August 2017
Source:Molecular Immunology, Volume 88
Author(s): Mai M. Abdelhafez, Jane Shaw, Damian Sutter, Jonas Schnider, Yara Banz, Hansjörg Jenni, Esther Voegelin, Mihai A. Constantinescu, Robert Rieben
Revascularization of an amputated limb within 4–6h is essential to avoid extensive ischemia/reperfusion (I/R) injury leading to vascular leakage, edema and tissue necrosis. I/R injury is a pathological inflammatory condition that occurs during reperfusion of an organ or tissue after prolonged ischemia. It is characterized by a complex crosstalk between endothelial cell activation and the activation of plasma cascades. Vasculoprotective pharmacological intervention to prevent I/R injury might be an option to prolong the time window between limb amputation and successful replantation. We used C1-easterase inhibitor (C1-INH) in this study because of its known inhibitory effects on the activation of the complement, coagulation and kinin cascades. Forelimbs of 8 large white pigs were amputated, subjected to ischemia, and then reperfused with autologous whole blood. All limbs were exposed to 9h of cold ischemia at 4°C. After 2h of cold ischemia the limbs were either perfused with of C1-INH (1U/ml in hydroxyethyl starch, n=8) or hydroxyethyl starch alone (n=7). After completion of the 9-h ischemia period, all limbs were ex vivo perfused with heparinized autologous whole blood for 12h using a pediatric heart lung machine to simulate in vivo revascularization. Our results show that I/R injury in the control group led to a significant elevation of tissue deposition of IgG and IgM, complement C3b/c, C5b-9 and MBL. Also, activation of the kinin system was significantly increased, namely bradykinin in plasma, and expression of bradykinin receptors 1 and 2 in tissue. In addition, markers for endothelial integrity like expression of CD31, VE-cadherin and heparan sulfate proteoglycans were decreased in reperfused tissue. Limb I/R injury also led to activation of the coagulation cascade with a significant elevation of fibrin and thrombin deposition and increased fibrinogen-like protein-2 expression. C1-INH treated limbs showed much less activation of plasma cascades and better protection of endothelial integrity compared to the reperfused control limbs. In conclusion, the use of the cytoprotective drug C1-INH significantly reduced I/R injury by protecting the vascular endothelium as well as the muscle tissue from deposition of immunoglobulins, complement and fibrin.



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RAG2 involves the Igκ locus demethylation during B cell development

Publication date: August 2017
Source:Molecular Immunology, Volume 88
Author(s): Caijun Wu, Yanying Dong, Xiaohui Zhao, Ping Zhang, Mingzhe Zheng, Hua Zhang, Shichang Li, Yaofeng Jin, Yunfeng Ma, Huixun Ren, Yanhong Ji
The genes encoding the immunoglobulin κ light chain are assembled during B cell development by V(D)J recombination. For efficient rearrangement, the Igκ locus must undergo a series of epigenetic changes. One such epigenetic mark is DNA methylation. The mechanism that the Igκ locus is selectively demethylated at the pre-B cell stage has not previously been characterized. Here, we employed bisulfite DNA-modification assays to analyze the methylation status of the Igκ locus in primary pre-B cells from RAG-deficient mice with pre-rearranged Igh knock-in allele. We observed that the Igκ locus was hypermethylated in RAG2-deficient pre-B cells but hypomethylated in RAG1-deficient pre-B cells, indicating that wild-type (WT) RAG2 involves the Igκ locus demethylation in a RAG1-independent manner prior to rearrangement. We generated a series of RAG2 mutants between residue 350 and 383. We showed that these mutants mediated the Igκ rearrangement but failed to regulate the Igκ gene demethylation. We further analyzed that these mutants could increase RAG recombinase activity in vivo. We conclude that residues 350–383 region are responsible for endogenous Igκ locus demethylation at pre-B cells. We propose that WT RAG2 has an intrinsic function to regulate the Igκ locus demethylation.



http://ift.tt/2rNxPel

Advantages of targeting B cell receptor complex to treat B-cell derived autoimmune diseases and lymphomas

Publication date: August 2017
Source:Molecular Immunology, Volume 88
Author(s): Jemal Adem, Mine Eray, Jonna Eeva, Ulla Nuutinen, Jukka Pelkonen
Antibodies produced by B-cells provide protection from infectious agents. However, impaired cell death signaling pathways in B-cells can lead to cancer, immunodeficiency or autoimmune diseases. B-cell signaling molecules such as CD20, CD19, Btk, and BAFF-R are targeted by therapeutic drugs and used to treat B-cell derived lymphomas or autoimmune diseases. Nevertheless, B-cells could develop resistance to these therapeutic drugs or the therapeutic drugs may have off-target effects. For instance, repeated rituximab (anti-CD20 antibody) treatment may lead to the loss of its target cell surface molecule, CD20. In addition, in B-cell malignancies, loss of CD19 expression has been observed. Another target molecule, Btk is expressed not only in B-cells but also in mast cells, macrophages, and dendritic cells. Thus, targeting Btk could negatively regulate the functions of innate immunity. The expression of BAFF-R is thought to be restricted to B-cells but it is also expressed on T-cells. Targeting BAFF-R, therefore, may lead to depletion of T-cells in addition to B-cells. B cell receptor (BCR) expression and signaling, however, are critically important for development, differentiation and survival of B-cells. Moreover, BCR is exclusively expressed on B-cells, which makes it an excellent target to avoid off-target effects.



http://ift.tt/2sxhOpZ

Fathering after divorce: The influence of involvement and parenting styles on child outcomes

http://ift.tt/2rS3Z3s

Types vaderschap na echtscheiding

http://ift.tt/2smZnGi

Does the non-residential parent matter? On the link between parenting and self-esteem

http://ift.tt/2rRMxMD

Mitochondrial dysfunction induced by a SH2 domain-targeting STAT3 inhibitor leads to metabolic synthetic lethality in cancer cells [Cell Biology]

In addition to its canonical role in nuclear transcription, signal transducer and activator of transcription 3 (STAT3) is emerging as an important regulator of mitochondrial function. Here, we demonstrate that a novel inhibitor that binds with high affinity to the STAT3 SH2 domain triggers a complex cascade of events initiated...

http://ift.tt/2rMK4bk

Reply to van Hoorn: Social comparisons of “enough” are an informational signal [Social Sciences]

In response to our article (1), van Hoorn (2) suggests that our analysis focuses too narrowly on perceived need as the mechanism linking inequality to increased risk taking. The author does not dispute the evidence we present for the role of perceived need, but proposes an additional mechanism linking inequality...

http://ift.tt/2sxiw6Z

Reply to Slooten et al.: Viewing fisheries management challenges in a global context [Biological Sciences]

Slooten et al. (1) claim the survey respondents from New Zealand, one of 28 countries considered in our paper in PNAS (2), were strongly biased toward the fishing industry. The six survey responses comprised a range of background experience: three government/science respondents (added here as coauthors), including the National Institute...

http://ift.tt/2sPI7uu

Informational content of relative deprivation as a channel linking economic inequality to risk taking [Social Sciences]

The evidence that economic inequality (or relative deprivation) increases risk taking, as presented in PNAS by Payne et al. (1), is an insightful addition to a broader literature that finds that relative deprivation has distinct effects on individuals, not the least of which is their happiness, in addition to any...

http://ift.tt/2rMXB2z

Evidence of bias in assessment of fisheries management impacts [Biological Sciences]

Melnychuk et al.'s comments in PNAS (1) that successful fisheries management requires the "capacity to limit fishing pressure" and "scientists are generally unanimous in calling for stronger management" echo comments made in many earlier publications. However, their conclusions about specific fisheries and management approaches lack credibility. Their analysis relies on...

http://ift.tt/2toKm59

Entropy in molecular recognition by proteins [Biophysics and Computational Biology]

Molecular recognition by proteins is fundamental to molecular biology. Dissection of the thermodynamic energy terms governing protein–ligand interactions has proven difficult, with determination of entropic contributions being particularly elusive. NMR relaxation measurements have suggested that changes in protein conformational entropy can be quantitatively obtained through a dynamical proxy, but the...

http://ift.tt/2sxcjHZ

Crystal structures of the Burkholderia multivorans hopanoid transporter HpnN [Biochemistry]

Strains of the Burkholderia cepacia complex (Bcc) are Gram-negative opportunisitic bacteria that are capable of causing serious diseases, mainly in immunocompromised individuals. Bcc pathogens are intrinsically resistant to multiple antibiotics, including β-lactams, aminoglycosides, fluoroquinolones, and polymyxins. They are major pathogens in patients with cystic fibrosis (CF) and can cause severe...

http://ift.tt/2sxlCYn

Transposon mutagenesis identifies chromatin modifiers cooperating with Ras in thyroid tumorigenesis and detects ATXN7 as a cancer gene [Genetics]

Oncogenic RAS mutations are present in 15–30% of thyroid carcinomas. Endogenous expression of mutant Ras is insufficient to initiate thyroid tumorigenesis in murine models, indicating that additional genetic alterations are required. We used Sleeping Beauty (SB) transposon mutagenesis to identify events that cooperate with HrasG12V in thyroid tumor development. Random...

http://ift.tt/2sPuonL

High-mobility group box-1 as an autocrine trophic factor in white matter stroke [Neuroscience]

Maintenance of white matter integrity in health and disease is critical for a variety of neural functions. Ischemic stroke in the white matter frequently results in degeneration of oligodendrocytes (OLs) and myelin. Previously, we found that toll-like receptor 2 (TLR2) expressed in OLs provides cell-autonomous protective effects on ischemic OL...

http://ift.tt/2rNdK87

Stratospheric ozone over the United States in summer linked to observations of convection and temperature via chlorine and bromine catalysis [Earth, Atmospheric, and Planetary Sciences]

We present observations defining (i) the frequency and depth of convective penetration of water into the stratosphere over the United States in summer using the Next-Generation Radar system; (ii) the altitude-dependent distribution of inorganic chlorine established in the same coordinate system as the radar observations; (iii) the high resolution temperature...

http://ift.tt/2rN60CU

Treatment with diphenyl-pyrazole compound anle138b/c reveals that {alpha}-synuclein protects melanoma cells from autophagic cell death [Medical Sciences]

Recent epidemiological and clinical studies have reported a significantly increased risk for melanoma in people with Parkinson's disease. Because no evidence could be obtained that genetic factors are the reason for the association between these two diseases, we hypothesized that of the three major Parkinson's disease-related proteins—α-synuclein, LRRK2, and Parkin—α-synuclein...

http://ift.tt/2sxeuuY

Modeling gene regulation from paired expression and chromatin accessibility data [Biophysics and Computational Biology]

The rapid increase of genome-wide datasets on gene expression, chromatin states, and transcription factor (TF) binding locations offers an exciting opportunity to interpret the information encoded in genomes and epigenomes. This task can be challenging as it requires joint modeling of context-specific activation of cis-regulatory elements (REs) and the effects...

http://ift.tt/2sxesTS

Chemical probes to potently and selectively inhibit endocannabinoid cellular reuptake [Pharmacology]

The extracellular effects of the endocannabinoids anandamide and 2-arachidonoyl glycerol are terminated by enzymatic hydrolysis after crossing cellular membranes by facilitated diffusion. The lack of potent and selective inhibitors for endocannabinoid transport has prevented the molecular characterization of this process, thus hindering its biochemical investigation and pharmacological exploitation. Here, we...

http://ift.tt/2rNdVQS

An Exportin-1-dependent microRNA biogenesis pathway during human cell quiescence [Genetics]

The reversible state of proliferative arrest known as "cellular quiescence" plays an important role in tissue homeostasis and stem cell biology. By analyzing the expression of miRNAs and miRNA-processing factors during quiescence in primary human fibroblasts, we identified a group of miRNAs that are induced during quiescence despite markedly reduced...

http://ift.tt/2tp9oRC

Neurog2 and Ascl1 together regulate a postmitotic derepression circuit to govern laminar fate specification in the murine neocortex [Developmental Biology]

A derepression mode of cell-fate specification involving the transcriptional repressors Tbr1, Fezf2, Satb2, and Ctip2 operates in neocortical projection neurons to specify six layer identities in sequence. Less well understood is how laminar fate transitions are regulated in cortical progenitors. The proneural genes Neurog2 and Ascl1 cooperate in progenitors to...

http://ift.tt/2sxcnaH

Reconstitution of a minimal machinery capable of assembling periplasmic type IV pili [Microbiology]

Type IV pili (Tfp), which are key virulence factors in many bacterial pathogens, define a large group of multipurpose filamentous nanomachines widespread in Bacteria and Archaea. Tfp biogenesis is a complex multistep process, which relies on macromolecular assemblies composed of 15 conserved proteins in model gram-negative species. To improve our...

http://ift.tt/2rzU3fI

Probabilistic model predicts dynamics of vegetation biomass in a desert ecosystem in NW China [Ecology]

The temporal dynamics of vegetation biomass are of key importance for evaluating the sustainability of arid and semiarid ecosystems. In these ecosystems, biomass and soil moisture are coupled stochastic variables externally driven, mainly, by the rainfall dynamics. Based on long-term field observations in northwestern (NW) China, we test a recently...

http://ift.tt/2rN309G

Dynamic changes in murine forebrain miR-211 expression associate with cholinergic imbalances and epileptiform activity [Neuroscience]

Epilepsy is a common neurological disease, manifested in unprovoked recurrent seizures. Epileptogenesis may develop due to genetic or pharmacological origins or following injury, but it remains unclear how the unaffected brain escapes this susceptibility to seizures. Here, we report that dynamic changes in forebrain microRNA (miR)-211 in the mouse brain...

http://ift.tt/2swT5Cl

Dynamics of avian haemosporidian assemblages through millennial time scales inferred from insular biotas of the West Indies [Population Biology]

Although introduced hemosporidian (malaria) parasites (Apicomplexa: Haemosporida) have hastened the extinction of endemic bird species in the Hawaiian Islands and perhaps elsewhere, little is known about the temporal dynamics of endemic malaria parasite populations. Haemosporidian parasites do not leave informative fossils, and records of population change are lacking beyond a...

http://ift.tt/2rRCoiV

Phosphorylation and negative regulation of CONSTITUTIVELY PHOTOMORPHOGENIC 1 by PINOID in Arabidopsis [Plant Biology]

CONSTITUTIVELY PHOTOMORPHOGENIC 1 (COP1) plays crucial roles in various cellular processes via its E3 ubiquitin ligase activity in organisms, ranging from fungi to humans. As a key component in regulating various biological events, COP1 itself is precisely controlled at multiple layers. Here, we report a negative regulator of COP1, PINOID...

http://ift.tt/2toNUob

BOTOX® (Botulinum Toxin Type A) as Headache Prophylaxis in Chinese Participants With Chronic Migraine

Condition:   Migraine Disorders
Interventions:   Biological: botulinum toxin Type A;   Drug: placebo (sodium chloride 0.9 mg)
Sponsor:   Allergan
Not yet recruiting - verified June 2017

http://ift.tt/2tp5FUe

Open Label Study of BOTOX® (Botulinum Toxin Type A) as Headache Prophylaxis in Chinese Patients With Chronic Migraine

Condition:   Migraine Disorders
Intervention:   Biological: botulinum toxin Type A
Sponsor:   Allergan
Not yet recruiting - verified June 2017

http://ift.tt/2toWzqD

Apatinib Combined With Docetaxel in the Treatment of Advanced Esophageal Squamous Cell Carcinoma

Condition:   Advanced Esophageal Squamous Carcinoma
Intervention:   Drug: Apatinib
Sponsor:   The First Affiliated Hospital of Zhengzhou University
Recruiting - verified June 2017

http://ift.tt/2sPhk1A

First reported case of paratesticular seminoma in a postpubertal cryptorchid testis

Abstract

Cryptorchidism is a very common anomaly, affecting 2–4% of male infants and is more common in premature infants. The long-term outcome despite orchidopexy still remains problematic and controversial with a risk of developing cancer 5–10 times greater than normal. Paratesticular tumors are mostly benign and very rare in children however malignant paratesticular tumors do arise, the most common being rhabdomyosarcoma. Primary paratesticular seminoma is extremely rare by itself and in most cases is associated with foci of seminoma within the testis. To the best of our knowledge, our case represents the fourth reported case of paratesticular seminoma in the published literature and being the first one in cryptorchid testis.

http://ift.tt/2sx8O4g

Single-stage reconstruction for buccal mucosa tumor resection including the labial commissure using a facial artery musculomucosal flap and a vermilion advancement flap

Abstract

Resection of buccal mucosa tumors may occasionally involve the labial angle and peripheral skin. Reconstruction is required when the resection involves more than one-third of the lip. We describe a single-stage reconstruction using a facial artery musculomucosal (FAMM) flap and a vermilion advancement flap after buccal mucosa resection including the labial angle. A 62-year-old woman with carcinoma in situ of the buccal mucosa underwent tumor resection. The resection included the right labial angle and peripheral skin. The resection did not lead to a massive lip defect, but a wide defect resulted on the mucosal side. The defect on the mucosal side was reconstructed using a FAMM flap, while the vermilion defect was covered using a vermilion advancement flap. Reconstruction performed using the FAMM flap and vermilion advancement flap produced aesthetically and functionally satisfactory outcomes.

http://ift.tt/2sx8N0c

Complete cricotracheal transection due to blunt neck trauma without significant symptoms

Abstract

Laryngotracheal injuries are relatively rare but their mortality rate is fairly high. Complete disruption of trachea is extremely rare and a systematic approach is needed for early diagnosis and favourable outcome. The patients symptoms and physical signs do not necessarily correlate with the severity of the injuries and this case report highlights it. This is a case report of 25-year-old man who arrived to the emergency department 8 h after a motor accident in which a rope was wrapped around his neck. Because of the good general and respiratory condition of the patient on admission, the pathognomonic signs of laryngeal injury were not noticed. A computed tomographic scan showed distortion of cricotracheal framework. Flexible bronchoscopy showed cricotracheal transaction. Immediately, the endotracheal tube was advanced distal to the transection site under bronchoscopic guide and then after neck exploration primary end-to-end cricotracheal anastomosis was performed.

http://ift.tt/2swYYzx

Biological activity of glatiramer acetate on Treg and anti-inflammatory monocytes persists for more than 10years in responder multiple sclerosis patients

Publication date: Available online 19 June 2017
Source:Clinical Immunology
Author(s): Michela Spadaro, Francesca Montarolo, Simona Perga, Serena Martire, Federica Brescia, Simona Malucchi, Antonio Bertolotto
Glatiramer acetate (GA) is a widely used treatment for multiple sclerosis (MS), with incompletely defined mechanism of action. Short-term studies suggested its involvement in the modulation of anti-inflammatory cytokines and regulatory T cells (Treg), while long-term effect is still unknown.To investigate this aspect, we analyzed by flow-cytometry peripheral-blood Treg, natural killer (NK), CD4 and CD8 T-cells and anti-inflammatory CD14⁺CD163⁺ monocytes from 37 healthy donor and 90 RRMS patients divided in untreated, treated with GA for 12months and from 34 to 192months.While NK, CD4 and CD8 T-cells did not show any significant differences among groups over time, we demonstrated that GA increased the anti-inflammatory monocytes and restored the Treg level in both GA-treated groups. Both these effects are a characteristic of responder patients and are observed not just in short-term but even after as long as a decade of GA treatment.



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An application of internal objects to microlocal analysis in generalized function algebras

http://ift.tt/2toXdEu

Positive and Negative Antecedents of Purchasing Eco-friendly Products: A Comparison Between Green and Non-green Consumers

This study aims to analyze what drives and prevents the purchasing of eco-friendly products across different consumer groups and develops a conceptual model embracing the positive altruistic (care for the environmental consequences of purchasing), positive ego-centric (green self-identity and moral obligation), and negative ego-centric (perceived personal inconvenience of purchasing eco-friendly products) antecedents of eco-friendly product purchase intention and behavior. We empirically validate the conceptual model for green (n = 453) and non-green (n = 473) consumers (i.e., consumers who engage in a set of pro-environmental behaviors for environmental reasons versus consumers who do not engage in these behaviors). Data are analyzed using structural equation modeling and multi-group analysis of the two groups. The results confirm the relevance of the determining factors in the model and show significant differences in eco-friendly product purchasing patterns between green and non-green consumers. Altruistic motives are more important for green than for non-green consumers. Negative ego-centric motives affect the purchase intentions of non-green consumers more than the intentions of green consumers, whereas the impact of negative motives on behavior is stronger for green than for non-green consumers. The first contribution of this paper is the development and testing of a parsimonious model of eco-friendly products purchasing that embraces both positive (altruistic and ego-centric) and negative (ego-centric) antecedents, which have been theoretically suggested in the past but have rarely been empirically tested together. The second contribution of this study is that it develops insight into the specific antecedents of eco-friendly products purchasing for green and non-green consumers to assess potential similarities and differences in eco-friendly products purchasing process, the hypothesized antecedents, their impact on eco-friendly products purchase intention and behavior, and the intention-behavior relation.

http://ift.tt/2sPrRtM

Microlocal analysis in generalized function algebras based on generalized points and generalized directions

We develop a refined theory of microlocal analysis in the algebra G(Ω) of Colombeau generalized functions. In our approach, the wave front is a set of generalized points in the cotangent bundle of Ω, whereas in the theory developed so far, it is a set of nongeneralized points. We also show consistency between both approaches.

http://ift.tt/2tovdkj

Do I know you? How brand familiarity and perceived fit affect consumers' attitudes towards brands placed in movies

The present study uses Associative Network Theory to construct a model that explains effects of brand placement in movies. Based on a field experiment (n = 167), we investigate the effects of plot connection and prominence on brand attitude, as well as the mediating role of brand-movie fit and the moderating role of brand familiarity. Results show that more closely connecting a brand to the plot of a movie positively impacts brand attitude by increasing the perceived fit between the brand and the movie. Brand familiarity moderates the effect of the interaction between a placement's plot connection and prominence on brand attitude. When brand familiarity is high, there is no significant effect of plot connection on brand attitude, nor is this effect moderated by the prominence of the placement. However, when brand familiarity is low, both prominently and subtly connecting the brand to the plot of the movie positively influences brand attitude. More importantly, the effect of plot connection is significantly stronger when an unfamiliar brand is prominently placed, than when it is subtly placed.

http://ift.tt/2sPbOMC

The influence of country-of-origin stereotypes on consumer responses to food safety scandals: The case of the horsemeat adulteration

Food safety scandals are recurring events in the food industry worldwide and companies are not immune to these incidents. However, there is a paucity of studies that examine how consumers evaluate and respond to brands involved in food crises and how consumers' prejudicial views about brands may bias these responses. Following attribution theory, the current study analyzes the psychological mechanisms through which consumers form judgments about a brand's culpability in the aftermath of a food safety scandal. Furthermore, this study assesses how the dimensions of a brand's country-of-origin (perceived competence and perceived warmth) affect the mechanism of blame attribution. A real food crisis, the 2013 European horsemeat adulteration scandal, provides the framework for an experimental study with 816 Italian consumers. The results show that perceived country-of-origin warmth diminishes consumers' perceptions of internal locus, stability, and controllability of the food incident, thus decreasing consumers' attributions of blame toward the faulty brand. Perceived competence increases consumers' perceptions of the controllability of the harmful behavior which leads to higher attributions of blame. Higher blame attribution leads to lower intentions to buy the brand in the future. Furthermore, when consumers perceive the food scandal as highly severe and when they are highly ethnocentric, perceived competence diminishes consumers' perceptions of internal locus and stability of the food incident. The theoretical contribution of the study and practical implications for food brand managers are addressed. (C) 2016 Elsevier Ltd. All rights reserved.

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De gevolgen van (jeugd) werkloosheid voor de latere levenstevredenheid

http://ift.tt/2sPkZwk

Electric Car Extensions of Car Brands: Impact on Brand Personality, Extension Evaluation and Parent Brand Feedback

http://ift.tt/2toX5Vw

How Consumers' Media Usage Influences the Advertising Media Mix that Maximizes Campaign Recognition

http://ift.tt/2sPxE2z

Proceedings of the EuBIC Winter School 2017

The 2017 EuBIC Winter School was held from January 10th to January 13th 2017 in Semmering, Austria. This meeting gathered international researchers in the fields of bioinformatics and proteomics to discuss current challenges in data analysis and biological interpretation. This article outlines the scientific program and exchanges that took place on this occasion and presents the current challenges of this ever-growing field. Biological significance: The EUPA bioinformatics community (EuBIC) organized its first winter school in January 2017. This successful event illustrates the growing need of the bioinformatics community in proteomics to gather and discuss current and future challenges in the field. In addition to the organization of yearly meetings, the young and active EuBIC community aims to develop new collaborative open source projects, spread bioinformatics knowledge in Europe, and actively promote data sharing through public repositories. (C) 2017 Elsevier B.V. All rights reserved.

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Context Matters: Modeling the Impact of Context Perceptions on the Effectiveness of Brand Placement

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The Impact of Managerial Responses to Online Reviews on Consumers' Perceived Trust and Attitude

http://ift.tt/2smg6tg

Advertising Adaptation versus Standardization Effectiveness in Open and Closed Markets

http://ift.tt/2rRjtF5

PREDICTION OF RESPONSE TO NEO-ADJUVANT RADIOTHERAPY IN PATIENTS WITH LOCALLY ADVANCED RECTAL CANCER BY MEANS OF SEQUENTIAL 18F-FDG-PET

http://ift.tt/2smz6aQ

Prediction of Response to Neoadjuvant Radiotherapy in Patients With Locally Advanced Rectal Cancer by Means of Sequential 18FDG-PET

http://ift.tt/2rRjhpn

Paediatric airway infections

1C022D013D00

http://ift.tt/2tJiqbN

Incoming Mail, Outgoing Mail and Copies of Letters in the Ur-Utu Archive

http://ift.tt/2rRbqrH

Precision fluid management in continuous renal replacement therapy

http://ift.tt/2smbLX5

Shock-refractory ventricular fibrillation in a patient implanted with a left ventricular assist device

http://ift.tt/2rR1eQf

Pathological assessment of the rectal cancer resection specimen

http://ift.tt/2smmyAl

Unraveling scientific impact: Citation types in marketing journals

The number of citations a paper receives is the most commonly used measure of scientific impact. In this paper, we study not only the number but also the type of citations that 659 marketing articles generated. We discern five citation types: application, affirmation, negation, review and perfunctory mention (i.e., citing an article only indirectly without really using it). Prior literature in scientometrics recognizes that the former three types, on average, signal a higher level of scientific indebtedness than the latter two types. In our sample, these three types of citation represent only 15% of all citations. We also find different determinants of citation behavior across citation types. Across the 49 determinants we included, only 13 have the same effect across all citation types, of which only 5 are statistically significant across all citation types. For instance, we find a significant inverted U-effect of challenging commonly held beliefs on citation counts, but only for three of the citation types: affirmation, review and perfunctory mention. Our results encourage scientific stakeholders to move beyond mere citation counts to assess a paper's or a scholar's scientific contribution, as well as to devote greater attention to the citation process itself. (C) 2014 The Authors. Published by Elsevier B.V.

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Unraveling scientific impact: Citation types in marketing journals (vol 32, pg 64, 2015)

http://ift.tt/2totPyd

Myelodysplasia and liver disease extend the spectrum of RTEL1 related telomeropathies

Cardoso, SR; Ellison, ACM; Walne, AJ; Cassiman, D; Raghavan, M; Kishore, B; Ancliff, P; Cardoso, SR; Ellison, ACM; Walne, AJ; Cassiman, D; Raghavan, M; Kishore, B; Ancliff, P; Rodríguez-Vigil, C; Dobbels, B; Rio-Machin, A; Al Seraihi, AFH; Pontikos, N; Tummala, H; Vulliamy, T; Dokal, I; - view fewer (2017) Myelodysplasia and liver disease extend the spectrum of RTEL1 related telomeropathies. Haematologica 10.3324/haematol.2017.167056 . (In press). Green open access

http://ift.tt/2sOtHeh

BRCA1 and RAD51C Promoter Hypermethylation Confer Sensitivity to PARP Inhibitors in Patients with Platinum Sensitive Ovarian Carcinoma

Swisher, E; Harrell, MI; Lin, KK; Scott, CL; Goble, S; Oza, A; Coleman, RL; Swisher, E; Harrell, MI; Lin, KK; Scott, CL; Goble, S; Oza, A; Coleman, RL; Konecny, G; Tinker, AV; O'Malley, DM; Kristeleit, RS; Ma, L; Brenton, J; Bell-McGuinn, K; Oaknin, A; Leary, A; Mann, E; Giordano, H; Raponi, M; McNeish, I; Kaufmann, S; - view fewer (2017) BRCA1 and RAD51C Promoter Hypermethylation Confer Sensitivity to PARP Inhibitors in Patients with Platinum Sensitive Ovarian Carcinoma. Clinical Cancer Research , 23 (11 Suppl) 10.1158/1557-3265.OVCASYMP16-AP28 .

http://ift.tt/2toCHUw

Tools for analysis and evaluation of biocatalytic processes

Law, HEM; (2007) Tools for analysis and evaluation of biocatalytic processes. Doctoral thesis, (UCL) University College London. Green open access

http://ift.tt/2sOIZjo

THU0416 The usefulness of a musculoskeletal ultrasound (MUS) scoring system for 22 hand joints examination for the detection of early undifferentiated inflammatory arthritis and treatment decisions making in established inflammatory arthritis

Ciurtin, C; Ehrenstein, M; Leandro, M; Dey, D; Nandagudi, A; Morris, V; Giles, I; Ciurtin, C; Ehrenstein, M; Leandro, M; Dey, D; Nandagudi, A; Morris, V; Giles, I; Ioannou, J; Sen, D; Shipley, M; Isenberg, D; - view fewer (2012) THU0416 The usefulness of a musculoskeletal ultrasound (MUS) scoring system for 22 hand joints examination for the detection of early undifferentiated inflammatory arthritis and treatment decisions making in established inflammatory arthritis. Presented at: Annual European Congress of Rheumatology EULAR, Berlin, Germany.

http://ift.tt/2tooR4y

Molecular modeling to rationalize ligand-support interactions in affinity chromatography

Salvalaglio, M; Cavallotti, C; (2012) Molecular modeling to rationalize ligand-support interactions in affinity chromatography. Journal of Separation Science , 35 (1) pp. 7-19. 10.1002/jssc.201100595 .

http://ift.tt/2sOP1jF

Coping with work-related stressors and building resilience in mental health workers: A comparative focus group study using interpretative phenomenological analysis

Lamb, D; Cogan, N; (2015) Coping with work-related stressors and building resilience in mental health workers: A comparative focus group study using interpretative phenomenological analysis. Journal of Occupational and Organizational Psychology , 89 (3) pp. 474-492. 10.1111/joop.12136 .

http://ift.tt/2tooeaW

Locomotor adaptation is modulated by observing the actions of others

Patel, M; Roberts, RE; Riyaz, MU; Ahmed, M; Buckwell, D; Bunday, K; Ahmad, H; Patel, M; Roberts, RE; Riyaz, MU; Ahmed, M; Buckwell, D; Bunday, K; Ahmad, H; Kaski, D; Arshad, Q; Bronstein, AM; - view fewer (2015) Locomotor adaptation is modulated by observing the actions of others. Journal of Neurophysiology , 114 (3) pp. 1538-1544. 10.1152/jn.00446.2015 .

http://ift.tt/2sOzO2h

The role of the kinetochore-associated Dam1 complex during fission yeast mitosis

Griffiths, K; (2007) The role of the kinetochore-associated Dam1 complex during fission yeast mitosis. Doctoral thesis, (UCL) University College London. Green open access

http://ift.tt/2toGHnW

Kindler syndrome complicated by invasive squamous cell carcinoma of the palate

Publication date: Available online 20 June 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): H. Souldi, M.Y. Bajja, M. Mahtar
IntroductionKindler syndrome is a very rare, autosomal recessive genodermatosis characterized by skin fragility and photosensitivity in infancy with progressive poikiloderma.Case reportWe report the case of a young woman with a history of Kindler syndrome predominantly characterized by extensive involvement of the oropharyngeal mucosa. The patient presented with an ulcerative lesion of the palate. Computed tomography and biopsy concluded on unresectable invasive squamous cell carcinoma of the hard palate. Neoadjuvant chemotherapy was proposed, but the patient died after the first course of chemotherapy in a context of severe gastrointestinal mucositis and generalized sepsis.DiscussionMucosal manifestations of Kindler syndrome have been described in the literature, but very few cases of malignant transformation to squamous cell carcinoma have been reported, although it is a very well known, long-term complication of this disease. To our knowledge, this is the second reported case of Kindler syndrome complicated by invasive squamous cell carcinoma of the hard palate.



http://ift.tt/2touyiH

Quasi 3D modelling of vadose zone soil-water flow for optimizing irrigation strategies: Challenges, uncertainties and efficiencies

http://ift.tt/2sma8bM

Methodological perspectives on the application of compound-specific stable isotope fingerprinting for sediment source apportionment

http://ift.tt/2rQVrtF

THE RELATIONAL GEOMETRY OF THE PORT-CITY INTERFACE. CASE STUDIES OF GHENT, BELGIUM, AND AMSTERDAM, THE NETHERLANDS

This paper applies a relational approach to the study of port-city interfaces. Such approach allows us to analyse how actors are connected, transact and assign meaning and value to local development. Much of the literature and studies on the port-city interface have primarily focussed on late 20thcentury transformation processes at the urban waterfront. This fails to appreciate the often continued presence of port activity within cities and falls short in understanding how development agendas of port cities are relationally constituted. In this paper, we develop the hypothesis that the port-city interface is not a closed system, but a relational construct through which heterogeneous flows of actors, assets and structures coalesce and take place. Using this perspective, a conceptual framework capable of categorizing different relational port-city interfaces is presented and applied in a schematic way to the port cities of Ghent, Belgium, and Amsterdam, the Netherlands. By mapping the relational geometries of these port cities, our results show how both public and private actors through networking strategically relate in different ways, across different territorial scales, within different institutionalised structures and between different economic sectors. Analysing the relational geometries provide us with examples of different dynamic actor-relational interplays and how this results in particular development trajectories. Eventually, our approach questions the perceived geographical dichotomy between port and city. This paper ends with a discussion about the value of relational geography to an understanding of the diversity of port-cities.

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Lime-stabilisation of high plasticity swelling clay from Ethiopia

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Visual examination of changes in soil structural quality due to land use

http://ift.tt/2slTY2i

PCR-based detection of Listeria monocytogenes and Salmonella in a wide variety of foods with GENE-UP

http://ift.tt/2rQYke3

Validation of GENE-UP (bioMérieux) PCR-based detection of Listeria monocytogenes and Salmonella in a wide variety of foods

http://ift.tt/2slWd5u

Enterobius vermicularis Infection with Tuboovarian Abscess and Peritonitis Occurring during Pregnancy

Background: Extraintestinal Enterobius vermicularis infections are rare but may occasionally affect the female genital tract. Although mostly asymptomatic or causing minor clinical problems, they may lead to severe infectious complications. Methods: Case report and review of the pertinent English language literature. Results: A 31-year-old, 30-week-pregnant female was admitted with a clinical suspicion of appendicitis. At surgery, the appendix appeared normal, but generalized peritonitis of unclear origin was present. Eggs of Enterobius vermicularis were found upon microbiological and pathological examination. Because of persisting infectious disease, the patient underwent an elective caesarean section, and at that time the diagnosis of a right tuboovarian abscess was made, and salpingo-oophorectomy was performed. The pathology report confirmed the diagnosis of an E. vermicularis salpingo-oophoritis. Conclusion: This case was extraordinary because of a combination of tuboovarian abscess and generalized peritonitis with E. vermicularis infection occurring during late pregnancy. Ectopic enterobiasis should be considered in the differential diagnosis of pelvic infections of gynecological origin.

http://ift.tt/2rQHps0

A novel technique for ultrasound-guided central venous catheterization under short-axis out-of-plane approach: “stepwise flashing with triangulation”

Abstract

In ultrasound-guided central venous catheterization, there is no standard technique either for the needle tip visualization or for the adequate needle angle and entry to the skin with short-axis view under out-of-plane technique. In the present study, we propose a novel technique named "stepwise flashing with triangulation", and the efficacy of this technique is assessed. Before and after a didactic session in which the technique was explained, 12 novice residents were asked to position the needle tip on or into the imitation vessels and to avoid deeper penetration by using an agar tissue phantom with ultrasound guidance. "Stepwise flashing" technique was for stepwise visualization of the needle tip, and "triangulation" technique was for adequate needle angle and entry to the skin. After the session, the success rate was increased and a deeper penetration rate was decreased. This technique will help us to facilitate vascular access and to avoid complications in clinical settings.

http://ift.tt/2toffH3

Loont een sociaal VAPZ eigenlijk wel de moeite

http://ift.tt/2tnVJKP

De speedpedelec wordt fiscaal dan toch weer een fiets

http://ift.tt/2sORzP1

Niet verzekerd voor overstroming ?

http://ift.tt/2toirm2

De witte kassa in uw horecazaak : is die verzekerd ?

http://ift.tt/2sOvlfS

Variation in stem mortality rates determines patterns of above-ground biomass in Amazonian forests : implications for dynamic global vegetation models

Understanding the processes that determine above-ground biomass (AGB) in Amazonian forests is important for predicting the sensitivity of these ecosystems to environmental change and for designing and evaluating dynamic global vegetation models (DGVMs). AGB is determined by inputs from woody productivity [woody net primary productivity (NPP)] and the rate at which carbon is lost through tree mortality. Here, we test whether two direct metrics of tree mortality (the absolute rate of woody biomass loss and the rate of stem mortality) and/or woody NPP, control variation in AGB among 167 plots in intact forest across Amazonia. We then compare these relationships and the observed variation in AGB and woody NPP with the predictions of four DGVMs. The observations show that stem mortality rates, rather than absolute rates of woody biomass loss, are the most important predictor of AGB, which is consistent with the importance of stand size structure for determining spatial variation in AGB. The relationship between stem mortality rates and AGB varies among different regions of Amazonia, indicating that variation in wood density and height/diameter relationships also influences AGB. In contrast to previous findings, we find that woody NPP is not correlated with stem mortality rates and is weakly positively correlated with AGB. Across the four models, basin-wide average AGB is similar to the mean of the observations. However, the models consistently overestimate woody NPP and poorly represent the spatial patterns of both AGB and woody NPP estimated using plot data. In marked contrast to the observations, DGVMs typically show strong positive relationships between woody NPP and AGB. Resolving these differences will require incorporating forest size structure, mechanistic models of stem mortality and variation in functional composition in DGVMs.

http://ift.tt/2swkwMz

Two-character sets as subsets of parabolic quadrics

A two-character set is a set of points of a finite projective space that has two intersection numbers with respect to hyperplanes. Two-character sets are related to strongly regular graphs and two-weight codes. In the literature, there are plenty of constructions for (non-trivial) two-character sets by considering suitable subsets of quadrics and Hermitian varieties. Such constructions exist for the quadrics Q(+)(2n-1, q) subset of PG(2n - 1, q), Q(-)(2n + 1, q) subset of PG(2n + 1, q) and the Hermitian varieties H(2n - 1, q(2)) subset of PG(2n - 1, q(2)), H(2n, q(2)) subset of PG(2n, q2). In this note we show that every two-character set of PG(2n, q) that is contained in a given nonsingular parabolic quadric Q(2n, q) subset of PG(2n, q) is a subspace of PG(2n, q). This offers some explanation for the absence of the parabolic quadrics in the above mentioned constructions.

http://ift.tt/2rMdvdr

Valproic acid related idiosyncratic drug induced hepatotoxicity in a glioblastoma patient treated with temozolomide

Glioblastoma patients undergoing treatment with surgery followed by radiation and temozolomide chemotherapy often develop a state of immunosuppression and are at risk for opportunistic infections and reactivation of hepatitis and herpes viruses. We report the case of a 48-year-old glioblastoma patient who developed acute cholestatic hepatitis with hepatic failure during adjuvant treatment with temozolomide and the integrin inhibitor cilengitide. A viral hepatitis was excluded and valproic acid treatment was stopped. Upon normalisation of the liver tests, temozolomide treatment was resumed without perturbation of the liver tests. Valproic acid related idiosyncratic drug induced hepatotoxicity should be considered as a differential diagnosis in glioblastoma patients undergoing adjuvant therapy.

http://ift.tt/2swd04h

Ileocolic invagination as a complication of a cecal adenocarcinoma

http://ift.tt/2rLWiRj

Malignant giant solitary fibrous tumor of the mediastinum

Malignant giant solitary fibrous tumor (SFT) of the mediastinum is a rare neoplasm derived from mesenchymal tissue. Owing to its large size, a complete resection of the tumor can present many challenges, particularly given its proximity to vital neighboring structures. We report a successful en-bloc resection of a massive mediastinal SFT, which was compressing the inferior trachea and heart, by means of a median sternotomy and an anterior left thoracotomy. We emphasize the rarity of this uncommon mediastinal mass. Key points of mediastinal SFT are discussed.

http://ift.tt/2sw78bi

On the number of points on a plane algebraic curve on GF(q)[t]/t(n)

http://ift.tt/2rLWiAN

Oxidative stress and psychiatric morbidity in patients with facial acne

Summary

Background

Acne vulgaris is a common cosmetic problem that is frequently associated with psychosocial disturbances as well as increased oxidative stress. However, oxidative stress and psychological aspects have been studied separately in acne.

Objective

To evaluate the relationships between oxidative stress, anxiety, depression, and quality of life in acne patients.

Methods

Sixty patients with facial acne and 40 age- and sex-matched healthy individuals were included in the study. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS), and quality of life (QoL) was measured by the Cardiff Acne Disability Index. Disease severity was assessed using the Combined Acne Severity Classification. The serum levels of zinc and malondialdehyde (MDA) and total antioxidant capacity (TAC) were measured in patients and healthy subjects.

Results

The mean HADS scores for anxiety and depression were higher in patients than controls (P<.001 for both). Acne patients showed higher serum MDA and lower TAC and serum zinc levels compared with control subjects (P=.019, P<.001, and P=.028, respectively). Anxiety and depression scores did not correlate with oxidative stress parameters. Patients with moderate/severe acne had worse anxiety scores than mild acne (P=.048), and higher anxiety scores were associated with poorer quality of life (r=.436, P=.001).

Conclusion

Our results indicate that the high levels of anxiety and depression in patients with facial acne were not related to oxidative stress. Anxiety was more common than depression and was directly related to QoL impairment.

http://ift.tt/2sLsqnC

La dirofilariose cutanée

Publication date: Available online 19 June 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): M. Benzaquen, E. Marmottant, P. Parola, P. Berbis
La dirofilariose est une zoonose ubiquitaire touchant rarement l'Homme, liée à la transmission par un moustique d'un nématode du genre Dirofilaria. La dirofilariose cutanée, due à D. repens, se manifeste par des plaques inflammatoires évoluant vers la formation de nodules sous-cutanés ; ce tableau clinique peut faire évoquer une cellulite de Wells. La mise en évidence du nématode lors de l'exérèse du nodule, associée à son identification macroscopique, histologique et moléculaire par PCR, permet de confirmer le diagnostic. L'exérèse chirurgicale du nodule reste le traitement de référence. Le nombre de cas de dirofilariose cutanée humaine rapportés ces dernières années a augmenté, rendant nécessaire la connaissance de ce diagnostic.Dirofilariasis is a worldwide zoonotic infection that rarely affects humans and is caused by filarial nematodes of the genus Diroflaria transmitted by mosquitoes. Cutaneous dirofilariasis, due to D. repens, presents as inflammatory lesions that develop into subcutaneous nodules. These clinical symptoms may be consistent with Wells' cellulitis. Diagnosis of dirofilariasis involves demonstration of the presence of the nematode during skin biopsy and identification of the worm through macroscopic, histological and PCR analysis. Surgical resection of the nodule remains the gold standard treatment. The number of cases of human cutaneous dirofilariasis has increased in the recent years and the disease must not be misdiagnosed.



http://ift.tt/2tnYdbX

Development of key interventions and quality indicators for the management of an adult potential donor after brain death: a RAND modified Delphi approach.

Care pathways standardize care based on the latest evidence. The aim of the study was to identify and select a set of relevant key interventions and quality indicators in order to develop a specific care pathway for donation after brain death and to rigorously evaluate its impact. A RAND modified three-round Delphi approach was used to build consensus about potential key interventions and quality indicators identified in existing guidelines, review articles, process flow diagrams and the results of the Organ Donation European Quality System (ODEQUS) project. Comments and additional key interventions and quality indicators, identified in the first round, were evaluated in the following rounds and a subsequent physical meeting. This was conducted over a 4 month time period in 2016. A multidisciplinary panel consisting of 18 Belgian experts completed the three Delphi rounds. Out of a total of 80 key interventions assessed throughout the Delphi process, 65 were considered to contribute to the quality of care for the management of a potential donor after brain death (DBD); 11 out of 12 quality indicators were validated for relevance and feasibility. Detection of all potential DBD in the intensive care unit and documentation of cause of no donation were rated as the most important quality indicators. Using a Delphi approach, consensus was reached for a set of 65 key interventions and 11 quality indicators in the management of a potential DBD. This set is considered to be universally applicable in quality improvement programs for the care of potential DBD.

http://ift.tt/2svU6ud

Association schemes on the sets of lines of regular near hexagons

We examine under what conditions there exists an association scheme on the set of lines of a regular near hexagon with quads of order (s, t(2)) through every two points at distance 2. All regular near hexagons with such an association scheme are determined in the case s >= t(2). Unfortunately, the case t(2) > s is still open.

http://ift.tt/2rM4DEs

Spin-embeddings, two-intersection sets and two-weight codes

Let Delta be one of the dual polar spaces DQ(8, q), DQ(-) (7, q), and let e : Delta -> Sigma denote the spin-embedding of Delta. We show that e(Delta) is a two-intersection set of the projective space Sigma. Moreover, if Delta congruent to DQ(-) (7, q), then e(Delta) is a (q(3) + 1)-tight set of a nonsingular hyperbolic quadric Q(+) (7, q(2)) of Sigma congruent to PG(7, q(2)). This (q(3) + 1)-tight set gives rise to more examples of (q(3) + 1)-tight sets of hyperbolic quadrics by a procedure called field-reduction. All the above examples of two-intersection sets and (q(3) + 1)-tight sets give rise to two-weight codes and strongly regular graphs.

http://ift.tt/2sw8Ppf

Dual embeddings of dense near polygons

Let e: S -> Sigma be a full polarized projective embedding of a dense near polygon S, i.e., for every point p of S, the set H(p) of points at non-maximal distance from p is mapped by e into a hyperplane Pi(p) of Sigma. We show that if every line of S is incident with precisely three points or if S satisfies a certain property (P(de)) then the map p bar right arrow Pi p defines a full polarized embedding e* (the so-called dual embedding of e) of S into a subspace of the dual Sigma* of Sigma. This generalizes a result of [6] where it was shown that every embedding of a thick dual polar space has a dual embedding. We determine which known dense near polygons satisfy property (P(de)). This allows us to conclude that every full polarized embedding of a known dense near polygon has a dual embedding.

http://ift.tt/2rLwVzj

Some extremal problems for edge-regular graphs

We consider the class ER(n, d, lambda) of edge-regular graphs for some n > d > lambda, i.e., graphs regular of degree d on n vertices, with each pair of adjacent vertices having lambda common neighbors. It has previously been shown that for such graphs with lambda > 0 we have n >= 3(d - lambda) and much has been done to characterize such graphs when equality holds. Here we show that n >= 3(d - lambda) + 1 if lambda > 0 and d is odd and contribute to the characterization of the graphs in ER(n, d, lambda), lambda > 0, n = 3(d - lambda) + 1 by proving some lemmas about the structure of such graphs, and by classifying such graphs that satisfy a strong additional requirement, that the number t = t(u, v) of edges in the subgraph induced by the lambda common neighbors of any two adjacent vertices u and v is positive, and independent of u and v. The result is that there are exactly 4 such graphs: K-4 and 3 strongly regular graphs.

http://ift.tt/2svTc0O

Generalized Veronesean embeddings of projective spaces, part II: the lax case

We classify all embeddings theta : PG(n,K) -> PG(d, F), with d >= n(n+3)/2 and K, F skew fields with vertical bar K vertical bar > 2, such that 0 maps the set of points of each line of PG(n,K) to a set of coplanar points of PG(d, F), and such that the image of theta generates PG(d, F). It turns out that d = 1/2n(n + 3) and all examples "essentially" arise from a similar "full" embedding theta' : PG(n, K) -> PG(d,K) by identifying K with subfields of IF and embedding PG(d, K) into PG(d, F) by several ordinary field extensions. These "full" embeddings satisfy one more property and are classified in [5]. They relate to the quadric Veronesean of PG(n, K) in PG(d, K) and its projections from subspaces of PG(d, K) generated by sub-Veroneseans (the point sets corresponding to subspaces of PG(n,K)), if K is commutative, and to a degenerate analogue of this, if K is noncommutative.

http://ift.tt/2rM3ywI

A note on the spin-embedding of the dual polar space DQ⁻(2n+1,K)

In [6], Cooperstein and Shult showed that the dual polar space DQ(-)(2n+1, K), K = F-q, admits a full projective embedding into the projective space PG(2(n) - 1,K'), K' = F-q2. They also showed that this embedding is absolutely universal. The proof in [6] makes use of counting arguments and group representation theory. Because of the use of counting arguments, the proof cannot be extended automatically to the infinite case. In this note, we shall give a different proof of their results, thus showing that their conclusions remain valid for infinite fields as well. We shall also show that the above-mentioned embedding of DQ(-) (2n + 1, K) into PG(2(n) - 1, K') is polarized.

http://ift.tt/2svNMmH

The valuations of the near 2n-gon In

The maximal and next-to-maximal subspaces of a nonsingular parabolic quadric Q(2n, 2), n >= 2, which are not contained in a given hyperbolic quadric Q(+)(2n - 1, q) subset of Q(2n, q) define a sub near polygon I-n of the dual polar space DQ(2n, 2). It is known that every valuation of DQ(2n, 2) induces a valuation of I-n. In this paper, we show that also the converse is true: every valuation of I-n is induced by a valuation of DQ(2n, 2). We will also study the structure of the valuations of I-n.

http://ift.tt/2rMtN6d

A note on near hexagons with lines of size 3

We classify all finite near hexagons which satisfy the following properties for a certain t(2) is an element of {1, 2, 4}: (i) every line is incident with precisely three points; (ii) for every point x, there exists a point y at distance 3 from x; (iii) every two points at distance 2 from each other have either 1 or t(2) + 1 common neighbours; (iv) every quad is big. As a corollary, we obtain a classification of all finite near hexagons satisfying (i), (ii) and (iii) with t(2) equal to 4.

http://ift.tt/2sw78YN